Wei-Li Huang

The Role of Video-Assisted Thoracoscopic Surgery in Therapeutic Lung Resection for Pulmonary Tuberculosis

BACKGROUND Video-assisted thoracoscopic surgery (VATS) has been considered an effective diagnostic modality for pulmonary tuberculosis. Its feasibility in therapeutic lung resection, however, has not been validated. METHODS The medical records of patients who underwent VATS or a thoracotomy for therapeutic resection of pulmonary tuberculosis between January 2007 and March 2011 were reviewed for age, sex, indications for surgery, approach and procedures, preoperative sputum culture status, operative time, blood loss, hospital stay, and complications. RESULTS One hundred twenty-three patients were enrolled. Sixty-three were successfully treated using VATS and 60 were converted to thoracotomy. The number of VATS wedge resections was significantly higher (p = 0.004). Patients who underwent VATS had significantly less blood loss, shorter hospital stays, and fewer complications (p = 0.031, 0.000, and 0.022, respectively). Lesions treated with a pneumonectomy or that required thoracoplasty failed to be done using VATS (p = 0.054 and 0.002, respectively). Patients who underwent VATS had slightly more isolated lobectomies and significantly (p = 0.005) shorter hospital stays than did thoracotomy patients. Concomitant and isolated segmentectomies were done using VATS, but there were significantly fewer than for thoracotomy patients (p = 0.033). CONCLUSIONS Video-assisted thoracoscopic surgery is effective for therapeutic wedge resections, isolated lobectomies, and simple segmentectomies and lobectomies combined with wedge resections or segmentectomies for pulmonary tuberculosis. Tuberculosis lesions that require a pneumonectomy or thoracoplasty are still major challenges for VATS.

Uniportal video-assisted thoracoscopic surgery lobectomy and segmentectomy for pulmonary sequestration

Background Pulmonary sequestration is a rare disease whose development begins in the embryonic stage. Surgery is the definitive treatment for eliminating respiratory symptoms and preventing complications. Reports of uniportal video-assisted thoracoscopic surgery (VATS) lobectomy and segmentectomy for pulmonary sequestration are limited in the literature. This study analyzes the perioperative results of the uniportal approach and compared them with those of the multiportal approach for pulmonary sequestration. Methods We collected a VATS series in a single institute from 2007 to 2017. Adult patients diagnosed with pulmonary sequestration and who had received surgical intervention were included. The use of uniportal VATS began from 2016. The perioperative outcomes for uniportal and multiportal approaches were compared. Results A total of 19 patients (7 in the uniportal group and 12 in the multiportal group) were included. VATS segmentectomy was performed significantly more in the uniportal group (P=0.033). Shorter operative time, less intraoperative blood loss, shorter pleural drainage time, and shorter postoperative hospital stay were found for the uniportal group; however, the differences compared with the multiportal group were not significant. There was also no significant difference in perioperative parameters among patients who underwent wedge resection, segmentectomy and lobectomy, respectively. All patients were symptom-free in the follow-up. Conclusions The perioperative results for a series of uniportal VATS anatomical resections for pulmonary sequestration were found to be better than those obtained with the multiportal approach. Although a challenging procedure, uniportal VATS segmentectomy can be performed safely for pulmonary sequestration to preserve more healthy pulmonary parenchyma.

Staged bronchial closure in uniportal video-assisted thoracoscopic anatomical resection for lung cancer with calcified lymph nodes

Uniportal video-assisted thoracoscopic surgery (VATS) makes a breakthrough in these years. Even we have gained more experience and surgical skills of uniportal VATS, some elements, such as calcified perivascular lymph nodes, make the surgery challenging. In this series, we used staged bronchial closure (cut the bronchus first and then close it with stapler after dividing the pulmonary artery with calcified lymph node) as an approach for dealing with this challenging issue. Though the rate of intraoperative vessel injury is relatively high, we obtained ideal surgical outcome by using this technique in different lobes and segment of the lung.